Balding Blog

At the recent ISHRS meeting last week in Bangkok, the value of ketoconazole shampoo was also echoed by one of the guest experts in the field of hair loss.

https://www.tandfonline.com/doi/abs/10.1080/09546634.2019.1573309?scroll=top&needAccess=true&journalCode=ijdt20

In a 21-month study for 39 male patients aged 21 to 33 years with Hamilton Grade III AGA, treatment with 2% KTZ shampoo two to four times weekly resulted in progressive increase in pilary index (defined as hair shaft diameter in µm 1.5 cm from bulb obtained from computerized MOP Videoplan Kontron image multiplied by percentage of hairs in anagen phase obtained from trichogram) while unmedicated shampoo demonstrated slow linear pilary index decrease. 61 In another sixmonth study on 150 patients aged 18 to 65 years, 1% KTZ shampoo two to three times weekly increased hair shaft diameter significantly, but did not significantly modify mean hair density.45 A final study described the Accepted Manuscript Page 9 of 33 comparison of oral finasteride 1 mg/day only and 2% topical minoxidil only to combination therapies of oral finasteride with 2% topical minoxidil and oral finasteride with 2% KTZ shampoo for a year in 100 male patients with Hamilton Grades II to IV AGA. Oral finasteride with topical KTZ demonstrated significant clinical improvement compared to oral finasteride or topical minoxidil alone (p<0.01) and was comparable combining oral finasteride and topical minoxidil (p=0.3).

http://libgen.lc/scimag/ads.php?doi=10.1080/09546634.2019.1573309

So 20 years after the 1998 study, and we only got 2 more studies. Not super duper definitive, but very promising. I’m basically convinced to ad it to my routine.

I am in my 40s and have had FUT twice, both times with very high yield and good cosmetic results. I have had a bit over 3,000 total grafts total. My FUT scar in the back of my head also came out well. The scar itself is thin and is pretty hard to detect, even if I cut my hair short. Sometimes I think about having a third FUT. I have a decent amount of donor hair left. How risky is it for me to have a 3rd FUT surgery if the first two went well? Am I risking ruining my good results to date? What are the chances I could get a good FUT scar on the third surgery if the first two went well? Does my chance of a bad FUT scar increase with each subsequent procedure? Should I quit while I am ahead or push for another procedure if I want more hair on top? Thanks for your help, and many thanks for baldingblog. It is very well done and helpful.

3,000 grafts is most likely less than half of your donor supply, assuming that you are a typical Caucasian. I had three strip surgeries myself and have no scar as you don’t with two surgeries. The general rule of thumb for normal healers (not good ones like me) is that the scar risks increase with additional procedures. Considering your history, you might discuss other options with your surgeon such as another strip surgery with a trichophytic closure to minimize the scar. Alternatively, you can have the harvest done with FUE (Follicular Unit Excision) and not worry about a linear scar. The FUE is becoming more and more popular in the past few year and now reflects more than half of all hair transplant harvesting technologies done worldwide.

Two patients one day after surgery. Neither patient has crusting and are clean as can be. They will not be detectable within a few days after the hair transplant. The first patient had 1800 grafts (FUE) in a completely bald area and the second patient has 2800 grafts (strip surgery) which is easily hidden by his residual hair. I will continue to show post operative patients so that you, our readers who are afraid what they will look like, will see that they won’t look freaky.

I periodically show photos of patients after their surgeries because so many people are afraid of what they will look like right after the surgery. There are visions or war wounded heads in the minds of many people who think that after their hair transplant, they will announce to the world what they had done and have a full invasion of their privacy. As you can see in these picture, there is nothing much to see and styling can easily hide even the one man on the right who is just one day after the surgery by combing his existing hair forward. The man on the left is one day after surgery and had 1500 FUE grafts and we are showing both the recipient area and the donor area which should be completely undetectable in two more days. The man on the right had 2125 grafts by strip surgery and is 4 days post surgery with some mild pinkness still evident to the camera, not so much on looking at him face on. To see what terrible post-op care looks like, see here (https://baldingblog.com/2017/10/18/now-2-weeks-hair-transplant-cant-go-public-photo/) which is the results of poor washing techniques used immediately after surgery.

The two pictures are when I was 13 years old and I’m and 18 girl. My hairline shape is changing. Should I be worried about this?

The 18 year old picture needs better quality, but it does look like the shape is changing. This is not uncommon. I studied children from the age of 5 (both boys and girls) and saw rounded hairlines if preadolescent children change in both boys and girls as they got well into their teens. The rounded hairline when you were 13, has flattened out now and that is very common and normal. If you think that you are losing hair, then see a hair doctor.

These men clearly are using some medication to get those hairlines. Do you agree?

There is a suggestion of early results on the photos as they are, I assume, taken from the same place with a comb-over on the 2 month photo. It is always best to style the hair the same to see the differences clearly.

Nice early result

Article specifically about sexual side effects

Article evaluating the possibility of side effects that continue after quitting